Objective .– To test the hypothesis that bedside assessment of LVEF in ICU patients is accurate when performed using a new generation ultrasound stethoscope, thereby improving the clinical judgement of experienced intensivists.

Design .– Prospective descriptive clinical study.

Setting .– Medical-surgical ICU of a Teaching hospital.

Patients .– Ninety-four patients were studied (mean age: 60 ± 17 years; men: 71; mean simplified acute physiologic score [SAPS 2]: 41 ± 15), 63 being mechanically ventilated and 36 receiving vasopressors and/or inotropes.

Intervention and measurements .– LVEF was independently assessed clinically by the attending physician and visually by two experienced intensivists with expertise in transthoracic echocardiography (TTE) which was performed successively with a pocket-size miniaturized device and a full-feature echocardiographic system. LVEF was considered as increased (LVEF > 75%), normal (LVEF: 50 to 75%), moderately reduced (LVEF: 30 to 49%), or severely reduced (LVEF < 30%). For the purpose of the study, biplane LVEF value measured independently off-line was used as reference. Overall mean image quality grade of the miniaturized device was inferior to that of the full-feature system (5.9 ± 3.7 vs 6.9 ± 3.7: P = 0.0009). Diagnostic concordance between the clinically estimated LVEF and biplane LVEF was poor (Kappa: 0.33; 95%CI: 0.16–0.49) and not improved by the knowledge of a previously determined LVEF value (Kappa: 0.44; 95%CI: 0.22–0.66). In contrast, the diagnostic agreement was good between LVEF visually assessed using the ultrasound stethoscope and using the full-feature system (Kappa: 0.75; CI95%: 0.63–0.87) and between LVEF assessed on-line and biplane LVEF, regardless of the system used (Kappa: 0.75; CI95%: 0.64–0.87 and Kappa: 0.70; CI95%: 0.59–0.82, respectively).

Conclusions .– The use of an ultrasound stethoscope in ICU patients by front-line intensivists with expertise in echocardiography improves bedside assessment of LV systolic function and promises to increase the accuracy of the clinical judgment in prolonging physical examination. The potential therapeutic impact of such strategy remains to determine.